Let's take a look at autoimmune diseases that affect the liver.
It's important that you pay attention to
each one of these autoimmune differentials,
each one will be presenting a little bit differently, and
when it's time for you to identify this particular
autoimmune disease, there are certain markers
that become important for you.
One differential for chronic liver disease of
autoimmune nature would be autoimmune hepatitis.
And I'll give you the markers there, keep in mind
that these individuals with autoimmune hepatitis
have not touched a drop of alcohol in their entire life,
and most likely, a female autoimmune diseases.
Primary biliary cirrhosis will be another autoimmune
disease causing, eventually damage to the liver.
What I'd like for you to do next anatomically,
is think about diseases that will be taking place
within the liver, you'd then call this intrahepatic.
Or you're referring to diseases coming
out of the liver, that's extrahepatic, right?
Whenever you come out of the liver, the organ
system that you have immediately entered into
would be the biliary system.
So anytime that you hear an
attending, or you're reading a case,
and it says either intrahepatic, extrahepatic diseases,
then you know exactly as to what component
of their hepatobiliary system has been affected.
With primary biliary cirrhosis.
Where does your biliary system begin?
In the liver, you've heard of canaliculi.
And at some point, when all of the canaliculi have
come together and you've moved towards zone one.
Yes, you heard that correctly - zone
one, which contains your portal triad
and of the triad, you're dealing with your bile duct.
And then from there, you're going to leave your
liver, extrahepatic and start forming your biliary tree.
And at some point, I'll give you primary biliary cirrhosis,
you've heard of anti-AMA, anti-mitochondria antibodies,
which will play a huge role there.
We have another autoimmune disease,
but this is affecting more so your biliary tree.
and that's where your focus should be.
Outside of liver - extrahepatic.
This is called primary, but this time it's sclerosing.
What does sclerosis mean to you in pathology?
It means narrowing.
What's narrowing in primary sclerosing cholangitis?
Not the blood vessel, it's the bile duct.
Cholangio- means what in medicine?
The biliary tree.
Yeah we'll be focusing upon what's known as
PSC and I'll give you a marker that are called p-ANCA.
Overlapping syndrome, mean to say that if you have
autoimmune disease and it's causing damage to your liver,
There's every possibility that this autoimmune
disease may then spill over into the biliary tree.
What basis does sarcoidosis have being here with the liver?
But does sarcoidosis only deal with the lung, Dr. Raj?
No, don't do that anymore.
You've heard of non-caseating
granuloma sarcoidosis - everyone has.
Your patient most likely would be
a young African American female,
but the non-caseating granuloma
could be in a number of places.
Yes, it could be in the lung, no doubt.
But the non-caseating granuloma could also be
found in the skin perhaps, or maybe down in the liver,
hence sarcoidosis causing liver disease,
maybe perhaps of autoimmune nature.